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  • 2013 Slate of Candidates Posted

    The 2013 Slate of Candidates for APTA National Office now is available on the APTA website. It also may be found in the House of Delegates community documents. The Candidate webpage, including candidate statements will be posted on February 8, 2013. Elections for national office will be held at the 2013 House of Delegates on June 24, 2013. Please contact Angela Boyd in APTA's National Governance and Leadership Department for additional information.

    CMS to Host Conference Call on Functional Limitation Reporting Requirements on December 12

    Physical therapists are encouraged to attend a conference call hosted by the Centers for Medicare and Medicaid Services (CMS) on December 12, 1:30 pm ET, that will cover the new functional reporting requirements for outpatient physical therapy, occupational therapy, and speech language pathology services, effective January 1, 2013.

    Participants will learn how to report patient functional limitation information on claims using the 42 new nonpayable functional G-codes and 7 new severity/complexity modifiers on claims for physical therapy, occupational therapy, and speech language pathology services. These G-codes and modifiers will be required on selected claims for all outpatient therapy services. In addition, the G-codes and severity modifiers used in the functional reporting are required to be documented in the patient's medical record of therapy services. To ensure a smooth transition, CMS sets forth a testing period from January 1, 2013, until July 1, 2013. After July 1, 2013, claims submitted without the appropriate G-codes and modifiers would be returned unpaid.

    The call will include an overview of the new functional reporting requirement, including effective dates, and information on:

    • professionals and providers affected
    • nonpayable G-codes used to report functional limitations
    • modifiers used to report the severity of functional limitations
    • when reporting is required
    • documentation requirements

    A question and answer session also will be held.  

    The speaker for this call is Pamela R. West, PT, DPT, MPH.

    The presentation for the call will be posted at least 1 day in advance of the call on the FFS National Provider Calls webpage. In addition, the link to the slide presentation will be e-mailed to all registrants on the day of the call.

    Registration will close at 12:00 pm ET on the day of the call, or when available space has been filled.

    Call for Comments: Modifications for Joint Commission Ambulatory Care Standards

    Physical therapists practicing in Joint Commission-accredited ambulatory care settings may wish to comment on proposed revisions to the Comprehensive Accreditation Manual for Ambulatory Care. Comments are due December 10. Visit the Commission's website for instructions on providing input. 

    APTA Announces Member Innovators for Innovation Summit 2013

    Eighteen APTA members have been selected to share their innovative practice models with their colleagues during the upcoming Innovation Summit 2013:  Collaborative Care Models. These members were nominated by their chapters or sections because of their involvement in innovative care delivery models. The nominations were reviewed and scored by a panel of APTA member experts. 

    The innovators will receive funding to attend the Summit where they will interact with policy makers, payers, physical therapists and other health professionals as they explore the role of physical therapists in new models of health care delivery and payment. They will share information about their work with both onsite and virtual audiences. 

    The Innovation Summit will be held on March 8, 2013. The Summit program will include panel discussions on the role of physical therapists in accountable care organizations, patient-centered medical homes, bundling initiatives, new private payment models, and employer driven programs. Virtual attendees will attend the programming and interact with panelists and other attendees through an innovative online platform and social media. Registration now is open.

    The selected innovator are: Mark Amundson, PT, DSc, DPT, SCS, Private Practice Section; Michael Billings, PT, MS, CEEAA, Oregon Chapter; Andrea Branas, PT, MPT, MSE, CLT, Women’s Health Section and Oncology Section; Allison Daly, PT, DPT, Louisiana Chapter; Michael Eisenhart , PT, New Jersey Chapter;  Jay Irrgang, PT, PhD, ATC, FAPTA, Orthopaedic Section; Rich Larsen, PT, OCS, Wisconsin Chapter; Mike Lebec, PT, PhD, Acute Care Section; Judy Lindsay, PT, Pediatric Section; Thomas Moriarity, PT, OCS, South Carolina Chapter; Kim Nixon-Cave, PT, PhD, PCS, Pennsylvania Chapter;  Peter Rigby, PT,  Washington Chapter; Jennifer Sidelinker, PT, GCS, Geriatric Section; Mary Stilphen, PT, DPT,  Health Policy and Administration Section; Kristine Terrio, PT, MSHS, New Hampshire Chapter; Darin Trees, PT, DPT, CWS, Texas Chapter; Phil Tygiel, PT, MTC, Arizona Chapter; Chris Wilson, SPT, Ohio Chapter.

    New in the Literature: Supine Sleep Position and Infant Rolling Abilities (Early Hum Dev. 2012 Nov 21. [Epub ahead of print])

    The introduction of the supine sleep position to reduce the prevalence of Sudden Infant Death Syndrome has not altered the timing or sequence of infant rolling abilities, say authors of an article published online in Early Human Development. This information is valuable to health care providers involved in the surveillance of infants' development, they add. Original normative age estimates for these 2 motor abilities are still appropriate. 

    The aim of this study was to compare the order and age of emergence of rolling prone to supine and supine to prone before the introduction of back to sleep guidelines and 20 years after their introduction. The original normative data for the Alberta Infant Motor Scale (AIMS) were collected just prior to the introduction of back to sleep guidelines in 1992. Currently these norms are being reevaluated. Data of rolling patterns of infants 36 weeks of age or younger from the original sample (n=1,114) and the contemporary sample (n=351) were evaluated to compare the sequence of appearance of prone to supine and supine to prone rolls (proportion of infants passing each roll) and the ages of emergence (estimated age when 50% of infants passed each roll).

    According to the results, the sequence of emergence and estimated age of appearance of both rolling directions were similar between the 2 time periods.

    Stop the Therapy Cap: Contact Your Members of Congress on Monday

    APTA, in conjunction with the Therapy Cap Coalition, is launching a national grassroots campaign to "Stop the Therapy Cap" on Monday, December 3. The patient impact of the cap is the theme of Monday's campaign. Almost 50 associations, organizations and patient groups will be sending action alerts to their members. With about 30 days left until expiration of the therapy cap exceptions process, the goal is to create a significant surge in Congressional e-mails and phone calls urging members of Congress to stop the therapy cap from taking effect in 2013.  

    APTA has provided association members form letters and e-mails in its Legislative Action Center. To access the materials, log in to the website, click "Take Action" under "Stop the Medicare Therapy Cap and Prevent SGR Payment Cuts," and follow the instructions. If you have time, personalize the e-mail and let Congress know how the cap impacts your patients.

    Congress has been very clear: it will not take action without input from constituents. If you only send 1 advocacy e-mail or make 1 advocacy phone call this year, do it on Monday. 

    APTA will send out an Action Alert Monday morning with talking points and instructions for contacting your legislators. Also, ask your patients to e-mail or call their members of Congress on Monday using APTA’sPatient Action Center. For more information on APTA's advocacy efforts, visit the Medicare Therapy Cap website.

    Time is running out! Take 5 minutes on Monday and contact your legislators. You can make a difference and help prevent a hard Medicare therapy cap of $1,900 from being implemented in 2013.

    Online Access to Providers, Records Increases Clinical Services

    Allowing patients to e-mail their clinicians and access their records online is associated with more, not fewer, telephone calls, office visits, and clinical services in general, says a Medscape Medical News article based on a study published in the November 21 issue of JAMA.  

    Researchers studied the effect of an online Web portal for patients enrolled in Kaiser Permanente (KP) Colorado. The portal, called My Health Manager (MHM), connects to KP's electronic health record system. MHM allows patients access test results, request medicine refills, schedule nonurgent appointments, and exchange messages with their clinicians on nonurgent health issues.

    The authors measured the use of health care services by 44,321 users of MHM before and after KP Colorado adopted the system compared with health care use by an equal number of nonusers. All patients in the study were continuously enrolled in KP Colorado for at least 2 years from March 2005 through June 2010.

    Lead author Ted Palen, MD, PhD, MSPH, and coauthors found that the number of office visits by MHM users increased by 0.7 per member per year compared with nonusers. Telephone encounters rose at a smaller rate of 0.3 per member per year. The rates of after-hours clinic visits, emergency department encounters, and hospitalizations per 1,000 members per year rose significantly, by 18.7, 11.2, and 19.9, respectively. These patterns held true whether the patients were younger or older than 50 years, says the article.  

    In contrast, a 2007 KP study of this issue in the organization's Northwest region reported that office visits decreased between 7% and 10% for patients using the patient portal. At that time, however, only 6% of KP Northwest patients were signed up for it. Today, roughly 50% of all KP patients, and about 60% of those in Colorado, are logging on.

    Online access might have helped patients take more responsibility for their health care, which led them to use more services, Palen told Medscape Medical News. Or perhaps patients who signed up for MHM were already likely to use more services because of clinical characteristics that the study failed to control for. Future research will try to tease out cause and effect, he said.

    An even more important question to answer, said Palen, is the effect of the online clinician–patient relationship on clinical outcomes. If virtual visits lead to more face-to-face visits, does a patient's health necessarily improve as a result?

    CMS Clarifies Implementation Date for Home Health Functional Reassessment Requirements for 2013

    As a follow-up to the issuance of the Home Health Prospective Payment System Calendar Year (CY) 2013 Final Rule, the Centers for Medicare and Medicaid Services (CMS) has updated its website to clarify that the therapy provisions will be effective for episodes beginning on or after January 1, 2013. This clarification can be found under the first bullet on the CMS HHA Center Webpage.

    In the CY 2013 final rule published November 2, CMS finalized 3 revisions regarding the requirement that a qualified therapist complete a functional reassessment of the patient at the 14th and 20th visits and every 30 days:

    1.      If a qualified therapist missed a reassessment visit, therapy coverage would resume with the visit during which the qualified therapist completed the late reassessment, not the visit after the therapist completed the late reassessment.

    2.      When multiple therapy disciplines are involved, if the required reassessment visit was missed for any one of the therapy disciplines for which therapy services were being provided, therapy coverage would cease only for that particular therapy discipline.

    3.      In cases where the patient is receiving more than one type of therapy, qualified therapists must complete their reassessment visits during the 11th, 12th, or 13th visit for the required 13th visit reassessment and the 17th, 18th, or 19th visit for the required 19th visit reassessment. However, CMS also states in instances in which patients receive more than one type of therapy, if the frequency of a particular discipline, as ordered by a physician, does not make it feasible for the reassessment to occur during the specified timeframes without providing an extra unnecessary visit or delaying a visit, then it will still be acceptable for the qualified therapist from each discipline to provide all of the therapy and functionally reassess the patient during the visit associated with that discipline that is scheduled to occur closest to the 14th Medicare-covered therapy visit, but no later than the 13th Medicare-covered therapy visit. Likewise, a qualified therapist from each discipline must provide all of the therapy and functionally reassess the patient during the visit associated with that discipline that is scheduled to occur closest to the 20th Medicare-covered therapy visit, but no later than the 19th Medicare-covered therapy visit. 

    APTA is working with CMS to address issues that may arise regarding implementation of these provisions.

    For a comprehensive summary of the final rule, visit APTA's website. E-mail advocacy@apta.org with questions regarding implementation of the 2013 functional reassessment requirement changes.

    AARP Features APTA's 'Fit After 50' Campaign

    On Monday, AARP featured a guest blog post by APTA President Paul A. Rockar Jr, PT, DPT, MS, on its personal health blog. Rockar explains how APTA's Fit After 50 campaign aims to educate people aged 50 and older about the importance of staying fit and active and discusses the role that physical therapists play in restoring and improving motion in people's lives at any age.     

    HHS Posts Guidance on De-identification of PHI

    The Office of Civil Rights released guidance Monday regarding methods for de-identification of protected health information (PHI) in accordance with the HIPAA Privacy Rule. This guidance is intended to assist covered entities  understand what is de-identification, the general process by which de-identified information is created, and the options available for performing de-identification.

    The guidance, posted on the Department of Health and Human Services' website, explains the 2 methods that can be used to satisfy the Privacy Rule's de-identification standard—Expert Determination and Safe Harbor—using a question-and-answer format and provides a glossary of terms related to de-identification.

    APTA's Health Information Technology (HIT) webpage provides resources and updates on HIT program development and legislation, in addition to APTA's efforts with federal policymakers to educate them as to the importance of including physical therapists in HIT initiatives moving forward.  

    Charting Medicare: Who, What, and How Much

    November's Visualizing Health Policy, JAMA's monthly infographic series created by the Kaiser Family Foundation (KFF), takes a look at Medicare: who is covered by the program; what proportion of Medicare beneficiaries use at least 1 medical service in a year; how health care spending per person is growing more slowly for Medicare than for private insurance; and how rising health care costs and a growing population pose fiscal challenges to keeping Medicare solvent in the years ahead.

    Archived infographics are available on KFF's website.

    Last Call for Nominations to 'Fit After 50' Member Challenge

    APTA members have just 3 more days to submit nominations to the Fit After 50 Member Challenge. If you know a physical therapist or physical therapist assistant (must be an APTA member; it can be you) who is age 50 or older, fit, and encourages others to be active and fit, complete the brief online nomination form and submit it by November 30.

    Researchers Call for Fitness Promotion

    Researchers who found that the combination of statin treatment and increased fitness boosts survival in patients with dyslipidemia are calling for the medical profession, society, and governments to make concerted efforts to promote fitness, says a Heartwire article.

    Following a group of veterans with dyslipidemia for an average of 10 years, Peter F. Kokkinos, PhD, and colleagues show that both statin therapy and increased fitness lower mortality significantly and independently of other clinical characteristics.

    Participants in the study were assigned to 1 of 4 fitness categories based on peak metabolic equivalents achieved during exercise testing and 8 categories based on fitness status and statin treatment. The primary end point was all-cause mortality adjusted for age, body-mass index, ethnic origin, sex, history of cardiovascular disease, cardiovascular drugs, and cardiovascular risk factors. Researchers ascertained mortality from Veterans Affairs records on December 31, 2011.

    During a median follow-up of 10 years, 2,318 participants died. Mortality risk was 18.5% (935/5,046) in people taking statins vs 27.7% (1,386/4,997) in those not taking statins.

    In patients who took statins, risk of death decreased as fitness increased; for highly fit individuals the hazard ratio (HR) was 0.30 compared with a HR of 1 for the least fit.

    For patients not treated with statins, the HR for least fit participants was 1.35. This HR progressively decreased to 0.53 for those in the highest fitness category compared with the least-fit group treated with statins.

    The study is published online in The Lancet. In an accompanying editorial, Pedro C Hallal PhD, and I-Min Lee, MD, MPH, ScD, say that Kokkinos and colleagues "add to the large body of work on the benefits of physical activity or fitness for health. Irrespective of whether patients were prescribed statins, the physically fittest participants had a 60% to 70% reduction in all-cause mortality rates during follow-up, compared with the least fit."

    New Podcast: Measuring Physical Activity

    Physical activity and physical fitness are closely linkedthat is, a measure of an individual's habitual level of physical activity including exercise is closely correlated to his or her level of physical fitness. A new APTA podcast focuses on screening for inactivity. The podcast distinguishes between physical activity and physical fitness, explains the use of physical activity to screen for issues of impaired physical fitness, and provides information on what to do with the results of the screen. It also gives examples illustrating various types of patients and the role that physical activity plays in their overall health. 

    This new podcast is part of a web presence titled "Vital Signs and Other Patient Screenings" and is included in a series of podcasts titled "Extracting Hidden Gems from Simple Clinical Measures." This podcast combined with part 1 and part 2 of the podcast series "Inactivity: An Epidemic," available at www.apta.org/PreventionWellness, explains why information about physical activity is valuable, how to gather the data, and what to do with the data based on the different results obtained.

    APTA podcasts are prerecorded discussions and interviews, not live events. Members can listen to podcasts at their convenience by clicking on the links provided in News Now articles, visiting www.apta.org/podcasts/, or subscribing to APTA podcasts on iTunes.

    Research Briefs Offer Strategies to Curb Health Care Spending

    Providers can dramatically improve American health care by focusing on value instead of volume, eliminating wasteful and inappropriate care, applying the best available evidence to practice, enhancing patient safety, and strengthening primary care, says RAND Health in 1 of 4 new research briefs dedicated to flattening the trajectory of health care spending.

    In this new series, RAND outlines 4 broad strategies for constraining spending growth without compromising quality in the nation's market-oriented health care system: foster efficient and accountable providers, engage and empower consumers, promote population health, and facilitate high-value innovation.

    Learn more about RAND's proposals to make public reports more meaningful to consumers, encourage health at the local level, promote high-value innovation, and read key findings, by clicking on the briefs at the bottom of the tabbed topics areas.  

    Board of Directors Meeting To Be Broadcast Online

    For the first time, APTA’s Board of Directors meeting will be broadcast online, for viewing by members, when the Board convenes at APTA headquarters in Alexandria, Virginia, November 30 and December 1.

    All open sessions of the meeting will be livestreamed in their entirety, and archived video will be available until December 14, at www.apta.org/Livestream. The agenda for the meeting is posted on the same page.

    Based on viewer interest and feedback, APTA will determine whether and how often to broadcast future meetings.

    Deadline to Submit Nominations for APTA's 'Fit After 50' Member Challenge Approaches

    Nominate a deserving APTA member age 50 or older (yes, it can be you!) who is committed to being active and fit and who encourages others to be the same. Go to www.apta.org/FitAfter50/ and submit your nomination by November 30.

    HHS Releases Essential Health Benefits Proposed Rule

    The Department of Health and Human Services (HHS) released several proposed rules today dealing with insurance reforms, including the proposed rule "Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation." The proposed rule provides guidance to states on the essential health benefits (EHBs) that must be offered in most nongrandfathered qualified health plans (QHPs) that are offered in each state's affordable Health Insurance Exchanges ("Exchanges") as directed under the Affordable Care Act (ACA). The Exchanges are expected to create competitive marketplaces making health insurance plans more affordable for individuals. EHB applicability to Medicaid will be defined in a separate regulation. The Exchanges must become operational by January 1, 2014. (See related articles titled "Proposed Rule Protects Patients From Discriminatory Policies" and "HHS Proposes Incentives for Nondiscriminatory Wellness Programs in Group Health Plan.")

    The proposed rule outlines Exchange and issuer standards related to coverage of EHBs and actuarial value. The proposed rule reiterates the 10 mandatory EHB categories of (1) ambulatory patient services; (2) emergency services; (3) hospitalization; (4) maternity and newborn care; (5) mental health and substance use disorder services, including behavioral health treatment; (6) prescription drugs; (7) rehabilitative and habilitative services and devices; (8) laboratory services; (9) preventive and wellness services and chronic disease management; and (10) pediatric services (under age 19), including oral and vision care. States must create EHB benchmark plans from their default benchmark state health plans by adding any mandatory categories that are not in their default plans. These nongrandfathered health plans must offer balanced benefits not unduly weighted toward any one category. 

    The proposed rule includes that:

    • States would determine EHB-benchmark plans that would serve as  reference plans and would reflect both the scope of services and limits offered by a typical employer plans in that state. This would allow states to build on coverage that is already widely available, minimize market disruption, and provide consumers with familiar products. Additionally, it is intended to balance consumers’ needs for  comprehensiveness and affordability, as recommended by the Institute of Medicine in its report on EHBs;
    • The EHB-benchmark plan must not include benefit designs that discriminate on the basis of an individual's medical condition, or against specific populations as described in the statute;
    • A transitional policy for coverage of habilitative services be implemented that would provide states with the opportunity to define these services if not included in the base-benchmark plan; states could determine the services they choose to provide under the habilitative category;
    • Covered benefits must remain substantially equal to those covered by the EHB-benchmark plan;
    • Certain preventive services must be offered without cost-sharing;
    • Health benefit substitution could only occur within benefit categories, not between different benefit categories. States have the option to enforce a stricter standard on benefit substitution or prohibit it completely;
    • An issuer cannot provide an EHB benefit design that discriminates based on an individual’s age, expected length of life, or present or predicted disability, degree of medical dependency, quality of life, or other health conditions;
    • States may require that a [nongrandfathered] QHP cover additional benefits beyond the 10 EHB categories;
    • A (nongrandfathered) health insurance issuer that offers health insurance coverage in the individual or small group market—inside or outside of the Exchange—ensure that such coverage offers the EHB package; and
    • HHS' secretary review the plans after 2 years, then similar policy thereafter, to ensure that gaps in access to care are remediated or advances in the relevant evidence base are included.

    Finally, the Affordable Care Act describes the levels of coverage that of the EHB packages offered in the Exchanges: actuarial values of 60% for a bronze plan, 70% for a silver plan, 80% for a gold plan, and 90% for a platinum plan.

    APTA will be commenting on this proposed rule. Comments are due on or around December 20.

    APTA's Regulatory Affairs department will provide full summaries of the 3 proposed rules shortly.

    Proposed Rule Protects Patients From Discriminatory Policies

    The Department of Health and Human Services (HHS) today released a proposed regulation that would implement the policies in the Affordable Care Act that make it illegal for insurance companies to discriminate against people with preexisting conditions. The provisions in the proposed rule are related to fair health insurance premiums, guaranteed availability, guaranteed renewability, risk pools, and catastrophic plans. Notably, the proposed rule clarifies the approach used to enforce the applicable requirements of the Affordable Care Act with respect to health insurance issuers and group health plans that are nonfederal governmental plans. Additionally, this proposed rule would amend the standards for health insurance issuers and states regarding reporting, utilization, and collection of data under the Public Health Service Act, which established a process for reviewing unreasonable increases in premiums for health insurance coverage. The rule also revises the timeline for states to propose state-specific thresholds for rate review and approval by the Centers for Medicare and Medicaid Services.

    Comments on this proposed rule are due on or around December 26.

    See related articles titled "HHS Releases Essential Health Benefits Proposed Rule" and "HHS Proposes Incentives for Nondiscriminatory Wellness Programs in Group Health Plans."

    APTA's Regulatory Affairs department will provide full summaries of the 3 proposed rules shortly.

    HHS Proposes Incentives for Nondiscriminatory Wellness Programs in Group Health Plans

    A third proposed regulation issued today by the Department of Health and Human Services (HHS) offers amendments to regulations, consistent with the Affordable Care Act, regarding nondiscriminatory wellness programs in group health coverage. Nondiscriminatory wellness programs generally allow premium discounts, rebates, or modification to otherwise applicable cost sharing (including copayments and deductibles) in return for adherence to certain programs of health promotion and disease prevention.

    Specifically, these proposed regulations would increase the maximum permissible reward under a health-contingent wellness program offered in connection with a group health plan (and any related health insurance coverage) from 20% to 30% of the cost of coverage. In addition, the proposed regulations would further increase the maximum permissible reward to 50% for wellness programs designed to prevent or reduce tobacco use. These regulations also include other proposed clarifications regarding the reasonable design of health-contingent wellness programs and the reasonable alternatives they must offer in order to avoid prohibited discrimination.

    Comments on this proposed rule are due on or around January 26, 2013.   

    See related articles titled "HHS Releases Essential Health Benefits Proposed Rule" and "Proposed Rule Protects Patients From Discriminatory Policies."

    APTA's Regulatory Affairs department will provide full summaries of the 3 proposed rules shortly.

    APTA 'Improvement Standard' Statement Featured in AMA Publication

    A November 19 article in American Medical News, a publication of the American Medical Association (AMA), highlights APTA's statement on the recent legal settlement prohibiting Medicare contractors from denying coverage based on a patient's potential for improved health status.

    New Heard on the Hill Podcast Recognizes Veteran-specific Issues

    A new Heard on the Hill podcast provides a comprehensive update on APTA's Veterans Affairs (VA) and Armed Services initiatives, including a traumatic brain injury briefing held on Capitol Hill in September and discussions with the Federal Physical Therapy Section on recent developments in the Joining Forces Initiative. The podcast also addresses recruitment and retention efforts aimed at physical therapists in the VA.     

    NCOA Launches State Policy Toolkit for Advancing Falls Prevention

    The National Council on Aging's (NCOA) new State Policy Toolkit aims to organize and maximize community falls prevention assets and resources, and establish innovative policies and practices within states, communities, and organizations. The toolkit offers a compendium of suggested policy changes to advance falls prevention, categorized under 8 major goals. It outlines the opportunities, strategies, and examples of what is possible through education and engagement of key stakeholders.

    The toolkit can be used as a guide for promoting discussion and potential action on policy changes that are appropriate for the population, geographic location, partnerships, and culture of your community. Users can adapt a limited, manageable set of strategies from the toolkit to put into action; include a set of indicators to measure progress of select recommendations; and review the resource compendium to find materials to promote strategic partnerships with providers.   

    APTA is a member of NCOA's Falls Free Coalition.

    For additional patient care and consumer education resources on this topic, visit APTA's Balance and Falls webpage.

    Aerobic Exercise Beneficial for Patients With Cancer-related Fatigue

    Aerobic exercise can be regarded as beneficial for individuals with cancer-related fatigue during and postcancer therapy, specifically those with solid tumors, say authors of an updated version of an original Cochrane review published in The Cochrane Library in 2008.    

    For this update, the authors searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, British Nursing Index, AMED, SIGLE, Dissertation Abstracts International, and reference lists of all studies identified for inclusion and relevant reviews. In addition, they hand-searched relevant journals and contacted experts in the field of cancer-related fatigue.

    They identified a total of 56 studies (4,068 participants) for inclusion (28 from the original search and 28 from the updated search), with the majority carried out in participants with breast cancer (28 studies). A meta-analysis of all fatigue data, incorporating 38 comparisons, provided data for 1,461 participants who received an exercise intervention and 1,187 control participants. At the end of the intervention period exercise was seen to be statistically more effective than the control intervention. Benefits of exercise on fatigue were observed for interventions delivered during or postadjuvant cancer therapy. In relation to diagnosis, the authors identified benefits of exercise on fatigue for breast and prostate cancer but not for those with hematological malignancies. Aerobic exercise significantly reduced fatigue, but resistance training and alternative forms of exercise failed to reach significance.

    "We're not expecting people to go out and be running a mile the next day," Fiona Cramp, who worked on the analysis at the University of the West of England in Bristol, told Reuters News. "Some people will be well enough that they're able to go for a jog or go for a bike ride, and if they can, that's great. But we would encourage people to start with a low level."

    Online Atlases Illustrate Prevalence of Diabetes, Obesity, and Physical Inactivity

    The Centers for Disease Control and Prevention (CDC) has introduced a new online tool, Diabetes Interactive Atlases, which provides data for diagnosed diabetes, obesity, and leisure-time physical inactivity at the national, state, and county levels. The new tool also includes interactive motion charts showing trends in the growth of diabetes and obesity throughout the United States and within states.

    The tool was launched with the release of CDC's November 15 Morbidity and Mortality Weekly Report, which highlights a study that found that the prevalence of diagnosed diabetes increased in all US states, the District of Columbia, and Puerto Rico between 1995 and 2010. During that time, the prevalence of diagnosed diabetes increased by 50% or more in 42 states, and by 100% or more in 18 states.

    The states with the largest increases are Oklahoma (226%), Kentucky (158%), Georgia (145%), Alabama (140%), and Washington (135%).

    RWFJ/AHA Collaboration Aims to Reverse Childhood Obesity

    The Robert Wood Johnson Foundation (RWJF) and the American Heart Association (AHA) have joined in an ambitious collaboration to reverse the nation's childhood obesity epidemic by 2015. RWJF will provide AHA with $8 million in initial funding to create and manage an advocacy initiative focused on changing local, state, and federal policies to help children and adolescents be more active and eat healthier foods.

    Under the new initiative, RWJF and AHA will focus on policy interventions to advance 6 priorities that research shows are likely to have the greatest impact on childhood obesity. AHA will develop the overarching strategy that connects efforts across all 6 priorities and will fund efforts in underserved communities for the last 3 of them:

    • improving the nutritional quality of snack foods and beverages in schools
    • reducing consumption of sugary beverages
    • protecting children from unhealthy food and beverage marketing
    • helping schools and youth-serving programs increase children's physical activity levels
    • increasing access to parks, playgrounds, walking paths, bike lanes, and other opportunities to be physically active
    • increasing access to affordable healthy foods

    Both RWJF and AHA will focus on reaching communities hardest hit by the epidemic, including communities of color and lower-income communities.

    HHS Pushes Exchange Declaration Letter Deadline to December 14

    For the second time in a week, the Department of Health and Human Services (HHS) has delayed the deadline requiring states to submit information for state-based exchanges. The most recent delay allows states to submit their letter of intent on December 14. In a letter sent yesterday to governors HHS says, "While submitting a letter of intent now will help us assist states in finalizing their application, a state may submit both a letter of intent and an application to operate its own Exchange by December 14." On December 9 HHS extended the blueprint application deadline from November 16 to December 14.   

    At the time the letter was released yesterday, 8 states—Arizona, Idaho, New Jersey, Oklahoma, Pennsylvania, Tennessee, West Virginia, and Wisconsin—were undecided as to whether they would create their own exchange or leave the task up to the federal government, according to The Hill.

    Registration Now Open for Innovation Summit

    APTA members are invited to participate in the association's groundbreaking event, Innovation Summit: Collaborative Care Models. Join our live-streamed presentation on March 8 to watch your colleagues, physicians, large health systems, and policy makers as they explore the role of physical therapy in current and emerging integrated models of care.

    The Innovation Summit offers a rare opportunity for leaders in health care who are participating in and at the decision-making helm of these models to gather for a series of discussions about models of care such as ACOs, medical homes, and bundled payment, and the role of physical therapy, with the goal of developing strategies for bolstering the involvement of physical therapists in these models.

    Register today to be a virtual attendee for this very special event. Your participation makes you eligible for 1.0 CEU. Learn more about how the Innovation Summit can benefit you.

    Latest Edition of PT in Motion Extra is Released

    The November issue of PT in Motion Extra, APTA's mobile-friendly, interactive complement to PT in Motion has just been published. Check it out! 

    This issue includes:

    Read this month's edition of Extra and tell APTA what you think by filling out this 5-question reader survey. You'll be entered into a drawing to win APTA's newest publication—Adult Fitness Examination: A Physical Therapy Approach, by Dan Millrood, PT, EdM—plus a packet of accompanying fill-in worksheets and client handouts (an $80 value). 

    New in the Literature: Physical Therapy Interventions for Knee Pain Secondary to OA (Ann Intern Med. 2012;157(9):632-644.)

    To evaluate physical therapy interventions for adults with knee osteoarthritis (OA), investigators from the University of Minnesota School of Public Health, University of Minnesota Medical School, and Minnesota Evidence-based Practice Center searched MEDLINE, the Cochrane Library, the Physiotherapy Evidence Database, Scirus, Allied and Complementary Medicine, and the Health and Psychosocial Instruments bibliography database from 1970 to February 2012.

    A total of 193 randomized, controlled trials (RCTs) published in English were included in the review. Means of outcomes, physical therapy interventions, and risk of bias were extracted to pool standardized mean differences. Disagreements between reviewers abstracting and checking data were resolved through discussion.

    Meta-analyses of 84 RCTs provided evidence for 13 physical therapy interventions on pain (58 RCTs), physical function (36 RCTs), and disability (29 RCTs). Meta-analyses provided low-strength evidence that aerobic (11 RCTs) and aquatic (3 RCTs) exercise improved disability and that aerobic exercise (19 RCTs), strengthening exercise (17 RCTs), and ultrasonography (6 RCTs) reduced pain and improved function. Several individual RCTs demonstrated clinically important improvements in pain and disability with aerobic exercise. Other physical therapy interventions demonstrated no sustained benefit. Individual RCTs showed similar benefits with aerobic, aquatic, and strengthening exercise. Adverse events were uncommon and did not deter participants from continuing treatment.

    Free full text of the article is available in Annals of Internal Medicine. A report on the review also is available from the Agency for Healthcare Research and Quality.  

    APTA member Becky Jo Olson-Kellogg, PT, DPT, GCS, coauthored the article.

    Move Forward to Host Radio Show on Holiday Shopping for Children With Special Needs

    APTA will host its next Move Forward radio show November 19 at noon ET on Holiday Shopping for Children With Special Needs. Two popular mommy bloggers, Ellen Seidman of Love that Max and Jennifer Byde Myers, a founder and editor of The Thinking Person's Guide to Autism and blogger at www.jennyalice.com, will share their personal experiences raising children with special needs and tips for holiday shopping. They also will discuss the role of physical therapy in their children's development. Joan Bohmert, PT, MS,will share her expertise as a physical therapist and discuss the impact that physical therapy can have on children with communication disabilities and developmental delays. For more information about the show and this initiative, click here. APTA's press release on the show is available at www.apta.org/.       

    IOM Provides Framework to Assess Community-based Prevention and Wellness Strategies

    A new report from the Institute of Medicine (IOM) proposes a framework to assess the value of community-based, nonclinical prevention policies and wellness strategies, especially those targeting the prevention of long-term, chronic diseases.

    The report's authors conclude that a comprehensive framework for valuing community-based prevention programs and poli­cies should meet 3 major criteria. First, the framework should account for ben­efits and harms in physical and mental health, community well-being, and community process. The physical and mental health domain includes reductions in the incidence and prevalence of dis­ease, declines in mortality, and increases in health-related quality of life.

    Second, the framework should consider the resources used and compare the benefits and harms associated with those resources. To effec­tively compare interventions, it is essential to quantify the magnitude of benefits in relation to the associated cost for each intervention.

    Third, the framework must take into account differ­ences among communities that can affect the link between interventions and outcomes.

    Because selecting 1 community-based prevention pol­icy or program over another can be difficult, the report recommends that decision makers weigh the ben­efits and harms to health, community well-being, and community process as they assign value to specific interventions.

    The authors caution that although a community-based preven­tion action may improve the overall health of a community, it may achieve more strikingly positive results among citizens with a certain income level or occupation, exacerbating health disparities. If achieving health equity is at odds with improving overall community health, priorities will have to be determined, they say.  

    Marquette Challenge in Full Swing

    The 25th annual Marquette Challenge officially launched at NSC 2012 and participating schools are holding various fundraising events around the country.

    This year's goal is to raise $200,000 to help reach a total of $2.5 million raised in 25 years of the Marquette Challenge.

    Make a Difference! Take the Challenge! Get started by learning more with the interactive Challenge kit.

    Click here to see the schools that have already pledged this year.

    If you're not receiving the Foundation for Physical Therapy's monthly News & Events e-newslettersign up today and stay current with the latest information on research supported by the Foundation, funding and awards, and events.

    New Podcast Series Focuses on Managing Patients With a Declining Functional Status

    Establishing appropriate and realistic goals and expected outcomes for patients with a declining functional status can be challenging – knowing that the ultimate trajectory of function is expected to be downward. A new APTA podcast series addresses the challenges of and suggests solutions for managing the care of these patients, who may have conditions such as Parkinson disease, muscular sclerosis, cystic fibrosis, or late-stage congestive heart failure.

    The first podcast begins with general functional status and safety examples. In upcoming podcasts physical therapists will share their experiences in applying these principles to specific patients with conditions that are characterized by a declining functional status.

    Benefits of Self-management for LBP Not Considered 'Worthwhile' by Patients

    Self-management interventions are widely recommended for patients with low back pain (LBP), but a meta-analysis by Australian researchers suggests that its effects on pain and disability are likely to be small and are supported by only moderate-quality evidence, says a Medscape Medical News article.

    The researchers included randomized controlled trials evaluating self-management for nonspecific LBP and assessing pain and disability in their review. They pooled data when studies were similar enough and divided analyses into short-term (less than 6 months after randomization) and long-term (at least 12 months after randomization) outcomes.

    They found 13 original trials that met inclusion criteria. Efficacy of self-management (including shared responsibility for a plan of care, self-monitoring, and management of signs and symptoms) was compared with efficacy of minimal intervention and with other interventions such as massage, acupuncture, yoga, and exercise.

    "The improvement [in pain and disability] was less than what is generally considered worthwhile by patients," said lead author Vincinius C. Oliveira. Specifically, the short-term improvement was -3.2 points on a 100-point scale for pain and -2.3 points for disability. According to the authors, effect sizes of 20% to 30% are needed for patients to consider interventions worthwhile.

    Dawn Carnes, DO, director of the National Council for Osteopathic Research and senior research fellow at the London School of Medicine and Dentistry in the United Kingdom, told Medscape that she was surprised by the strength of the authors' conclusion because small changes in large populations (such as LBP) do make a difference at a population level. 

    Carnes also voiced concerned about the review's inclusion criteria. She said, "[The authors] included all types of [LBP], including chronic. Why would you expect pain to improve in a chronic pain population, where drugs don't even work for these people? Similarly, disability is unlikely to change in chronic patients, especially those with permanent bony or physiological change."

    The researchers told Medscape that they "were surprised by lack of definition criteria for self-management. The study raised questions that our group is currently working on such as consensus on what self-management for [LBP] is among experts, including clinicians and researchers."

    In comparing self-management with minimal intervention, the authors found "moderate-quality evidence that self-management interventions have small but statistically significant effects, compared to minimal interventions, on pain and disability for LBP."

    In addition, they found only low-quality evidence that self-management is not better than massage, acupuncture, yoga, and exercise in reducing pain or disability in LBP.

    The study was published online October 27 and in the November print issue of Arthritis Care & Research.

    Low-intensity Exercise Shows Greatest Benefit for Patients With Parkinson Disease

    Physical activity, including walking on a treadmill and stretching and resistance exercise, appears to improve gait speed, muscle strength, and fitness for patients with Parkinson disease, say researchers at the University of Maryland. Their article is published online in Archives of Neurology.

    The researchers compared 67 people with Parkinson disease who were randomly assigned to 1 of 3 exercise groups: walking on a treadmill at low intensity for 50 minutes, higher-intensity treadmill training to improve cardiovascular fitness for 30 minutes, and using weights (leg presses, extensions and curls) and stretching exercises to improve muscle strength and range of motion. Participants exercised 3 times a week for 3 months under the supervision of exercise physiologists at the Baltimore VA Medical Center.

    The investigators found improved cardiovascular fitness in both the higher- and lower-intensity treadmill exercise groups. However, only the stretching and resistance exercises improved muscle strength (16% increase) during the study.

    One key measurement was distance covered during a 6-minute walk, where all 3 types of exercisers showed improvement compared with their baseline measurement: lower-intensity treadmill exercise (12% increase), stretching and resistance exercises (9% increase), and higher-intensity treadmill exercises (6% increase).

    "We are encouraged to see that the lower-intensity treadmill exercise, which is feasible for most Parkinson patients, proved to have the greatest benefit for mobility while also improving cardiovascular fitness," said Lisa Shulman, MD, the study's principle investigator.

    E. Ray Dorsey, MD, coauthor of an accompanying journal editorial, told HealthDay News, "I hope this study adds to the evidence that exercise should be the standard of care."

    HHS Extends Blueprint Deadlines for State-based, 2014 Partnership Exchanges

    In order to continue to provide states that are pursuing state-based exchanges with appropriate technical support, the Department of Health and Human Services (HHS) is extending the deadline for blueprint applications to Friday, December 14. Originally states had to provide federal regulators a blueprint by November 16, as outlined in HHS' final rule. The deadline for a declaration letter for a state-based exchange remains Friday, November 16, 2012. In a November 9 letter sent to governors, HHS says it will approve or conditionally approve the state-based exchanges for 2014 by the statutory deadline of January 1, 2013.

    HHS will accept declaration letters and blueprint applications for states that are pursuing state partnership exchanges and make approval determinations on a rolling basis. The final deadline for both the declaration letter and blueprint that would be effective for 2014 has been extended to Friday, February 15, 2013, says the letter. States will be able to apply to run these exchanges in subsequent years.

    Most qualified health plans offered in exchanges must include the 10 categories of essential health benefits (EHB) mandated by the Affordable Care Act, which include rehabilitative and habilitative services. HHS is expected to release the final rule on EHB in the near future.

    Lack of Vitamin D Associated With Greater Pain, Sensitivity in Black Americans

    A new study reveals that black Americans display lower levels of vitamin D and greater pain sensitivity than do white Americans. A Vitamin D deficiency may be a risk factor for increased knee osteoarthritic pain in black Americans, the authors conclude

    Clinical practice guidelines state that vitamin D levels less than 20 ng/mL represent deficiency, and levels between 21 and 29 ng/mL represent insufficiency. Given that low levels of vitamin D are linked to chronic pain and other health conditions, especially in black Americans, the research team set out to investigate if variations in vitamin D levels contribute to racial differences in patients with knee pain caused by osteoarthritis (OA).

    Researchers at the University of Florida and the University of Alabama at Birmingham recruited 94 participants—45 black and 49 white patients with symptomatic knee OA—to complete questionnaires regarding their symptoms. The study group was 75% female and an average 56 years old.

    In addition, study participants underwent testing that included sensitivity to heat and mechanical pain on the affected knee and the forearm. Researchers measured heat pain threshold as the point when patients indicate the sensation "first becomes painful" and pain tolerance when patients "no longer feel able to tolerate the pain." Mechanical pain measures were determined by the patients' response to pressure in the knee and forearm.

    Findings indicate that despite living in a southern sunny climate, 84% of black participants had vitamin D levels less than 30 ng/mL compared with 51% of white subjects. Furthermore, the average vitamin D level for black Americans was 19.9 ng/mL (deficiency), compared with white Americans who averaged 28.2 ng/mL (insufficiency). Black participants reported greater overall knee osteoarthritis pain, and those with lower vitamin D levels displayed greater sensitivity to heat and mechanical pain (experimental pain).

    "Our data demonstrate that differences in experimental pain sensitivity between the 2 races are mediated at least in part by variations in vitamin D levels," said lead author Toni Glover, MSN, ARNP. "However, further studies are needed to fully understand the link between low vitamin D levels and racial disparities in pain."

    AHRQ Launches Consumer-focused Podcast Series

    Healthcare 411, a new podcast series produced by the Agency for Healthcare Research and Quality (AHRQ), shares news and information about current research on important health care topics to help consumers with health care decision making.

    Content provided by the Healthcare 411 Web site includes interviews that range from 60 seconds to 15 minutes on a variety of health topics. Programs remain available and searchable on the Healthcare 411 site. The site also hosts audio and video public service announcements produced by AHRQ and provides links to related consumer publications and other studies and guides funded by AHRQ.

    APTA Launches Functional Limitation Reporting Webpage

    APTA has launched a webpage with background information and resources, including a comprehensive FAQ document, to help physical therapists meet a new functional limitation reporting requirement. 

    The Centers for Medicare and Medicaid Services (CMS) will begin to collect information via claim forms on January 1, 2013, regarding the beneficiary's function and condition, therapy services furnished, and outcomes achieved. To ensure a smooth transition, CMS sets forth a testing period from January 1, 2013, until July 1, 2013. After July 1, 2013, claims submitted without the appropriate G-codes and modifiers will be returned unpaid.

    Additional resources will be added to the webpage in the coming months. Check back soon for a webinar update on Medicare 2013, podcasts on functional limitation reporting and case examples, and more.

    Registration Deadline for PQRS Audio Conference is November 12

    On November 15, APTA will hold an audio conference to help educate members on changes to the Physician Quality Reporting System (PQRS) for 2013. Physical therapists (PTs) who bill Medicare for outpatient physical therapy services in private practice settings (using the 1500 claim form or 837-P) can obtain a 0.5% bonus payment in 2013 under PQRS. In addition, PTs who successfully report under the PQRS program in 2013 will avoid the 1.5% reduction in payment from Medicare in 2015.

    Registration closes Monday, November 12. Register today.

    APTA's highlights of the 2013 final physician fee schedule rule provides details on PQRS,  claims and reporting requirements, and group measures.  

    Joint Commission Posts Prepublication Standards for PCMH Certification Options

    The Joint Commission recently posted prepublication standards for its Primary Care Medical Home (PCMH) Certification options for accredited hospitals and critical access hospitals

    The PCMH requirements relate to the following 5 operational characteristics:

    • patient-centered care
    • comprehensive care
    • coordinated care
    • superb access to care
    • systems-based approach to quality and safety

    The requirements are effective January 1, 2013.

    Launched in July 2011, PCMH Certification for Joint Commission-accredited ambulatory care organizations focuses on care coordination, access to care, and how effectively a primary care clinician and interdisciplinary team work in partnership with the patient (and where applicable, his or her family). PCMH certification is consistent with the new federal health care reform efforts to improve health outcomes and the continuity, quality, and efficiency of health care services.

    New POS Code Established at APTA's Urging

    APTA's request for a new place of service (POS) code to indicate that a physical therapist (PT) delivered services at a patient’s worksite recently was granted by the Centers for Medicare and Medicaid Services (CMS). Place of service codes are 2-digit codes placed on health care claims to indicate the setting in which a service was provided. The new code is available for use effective January 1, 2013, but will not be effective for Medicare until May 1, 2013.

    The new code, POS 18, is named "place of employment-worksite." Per the description, the code should be used when physical therapy is delivered at "A location, not described by any other POS code, owned or operated by a public or private entity where the patient is employed, and where a health professional provides on-going or episodic occupational medical, therapeutic or rehabilitative services to the individual."

    PTs delivering services that are appropriately reported using POS codes should check with payers to determine if they are prepared to accept POS 18.

    Examples of situations in which POS 18 can be used include, but are not limited to:

    • Job site analysis to identify potential accommodations – patient present and participating in the service
    • Job coaching to improve biomechanics at the work site – patient present and participating in the service
    • Physical therapy evaluation and treatment at the worksite
    • Functional capacity evaluations at the worksite to determine the worker's ability to perform specific job duties

    Currently, PTs are likely to report POS 99, known as "other place of service," when delivering services at the worksite. The addition of POS 18 will enable PTs, payers, and others using POS code data to more accurately identify where services are delivered. Health plans can use this information to implement payment differentials when providers are required to travel in order to deliver services, and to study the costs and benefits of alternative service delivery options.

    In its request to CMS for the new POS code, APTA noted that the provision of physical therapy (and other medical) services at the place of work reduces lost productivity, enhances the effectiveness of job-specific training, and improves access to services where transportation and other barriers may exist. The association also told the agency that workers are more likely to receive the health care services they need in order to remain productive in the workforce when services are easily accessible. Additionally, job-specific evaluation and training services, including job and/or ergonomic analysis, must be performed at the work site and therefore are not appropriately reported using other place of service codes (except POS 99, which is nonspecific).

    CMS maintains POS codes used throughout the health care industry. Additional information about POS codes is available on CMS' website. CMS will publish a change request in the near future to inform payers of the change. Meanwhile, the updated list of codes is available here.

    New in the Literature: Screening for Clinically Important Cervical Spine Injury (CMAJ. 2012;184(16):E867-E876.)

    Based on studies with modest methodologic quality and 1 direct comparison, the Canadian C-spine rule appears to have better diagnostic accuracy than the National Emergency X-Radiography Utilization Study (NEXUS) criteria when used to assess the need for cervical spine imaging, say authors of a systematic review published in CMAJ. Future studies need to follow rigorous methodologic procedures to ensure that the findings are as free of bias as possible, they add.

    For this review, the authors identified studies by an electronic search of CINAHL, Embase, and MEDLINE. They included articles that reported on a cohort of patients who experienced blunt trauma and for whom clinically important cervical spine injury detectable by diagnostic imaging was the differential diagnosis, evaluated the diagnostic accuracy of the Canadian C-spine rule or NEXUS or both, and used an adequate reference standard. They assessed the methodologic quality using the Quality Assessment of Diagnostic Accuracy Studies criteria. They used the extracted data to calculate sensitivity, specificity, likelihood ratios, and posttest probabilities.

    Fifteen studies of modest methodologic quality were included in the review. For the Canadian C-spine rule, sensitivity ranged from 0.90 to 1.00 and specificity ranged from 0.01 to 0.77. For NEXUS, sensitivity ranged from 0.83 to 1.00 and specificity ranged from 0.02 to 0.46. One study directly compared the accuracy of these 2 rules using the same cohort and found that the Canadian C-spine rule had better accuracy. For both rules, a negative test was more informative for reducing the probability of a clinically important cervical spine injury.

    Life Expectancy Longer for People Who Engage in Leisure-time Physical Activity

    Leisure-time physical activity is associated with longer life expectancy, even at relatively low levels of activity and regardless of body weight, according to researchers at the National Cancer Institute, part of the National Institutes of Health (NIH).

    In order to determine the number of years of life gained from leisure-time physical activity in adulthood, researchers examined data on more than 650,000 adults, mostly aged 40 and older, who took part in 1 of 6 population-based studies that were designed to evaluate various aspects of cancer risk.

    After accounting for other factors that could affect life expectancy, the researchers found that life expectancy was 3.4 years longer for people who reported they got the recommend level of physical activity (2.5 hours at moderate intensity/1.25 hours at vigorous intensity each week). People who reported leisure-time physical activity at twice the recommended level gained 4.2 years of life.

    The researchers even saw benefit at low levels of activity. For example, people who said they got half of the recommended amount of physical activity still added 1.8 years to their life.

    The researchers found that the association between physical activity and life expectancy was similar between men and women, and blacks gained more years of life expectancy than whites. The relationship between life expectancy and physical activity was stronger among people with a history of cancer or heart disease than among those with no history of cancer or heart disease.

    The researchers also examined how life expectancy changed with the combination of both activity and obesity. Obesity was associated with a shorter life expectancy, but physical activity helped to mitigate some of the harm. People who were obese and inactive had a life expectancy that was between 5 to 7 years shorter (depending on their level of obesity) than people who were normal weight and moderately active.

    The study was published online November 6 in PLoS Medicine.

    APTA Statement: GAO Report a 'Huge Step Forward' in Exposing Abuse in Self-referral

    "APTA stands for fair and honest practice in health care and appreciates the work and findings of a recent report produced by the US Government Accountability Office (GAO)," says APTA President Paul Rockar Jr, PT, DPT, MS, in a statement on the "shocking" rates of self-referred imaging services compared with non-self-referred services.

    The report, which was released last week and reported on in News Now, found that self-referred magnetic resonance imaging (MRI) services increased by approximately 84% from 2004 to 2010, whereas non-self-referred MRI services only increased by roughly 12%. For computed tomography (CT) over the same time period, the number of services performed by self-referrers increased by approximately 107%, in contrast to an increase of roughly 30% by non-self-referrers.

    Also of significance is the finding that providers who began self-referring in 2009, known as "switchers," increased MRI and CT referrals by an average of 67% in 2010. The GAO concluded that "financial incentives for self-referring providers were likely a major factor driving the increase in referrals."  

    "The GAO report, the first of a series that will scrutinize the use of the IAOS exception and self-referral, including in physical therapy, clearly shows that such practices only serve to exponentially increase spending and, more important, raise risks to beneficiaries," says Rockar.

    PTs Unite to Raise Money for Colleagues Affected by Hurricane Sandy

    A consortium of physical therapy groups including Evidence In Motion, E-Rehab, BreakThrough Physical Therapy, PT Development, the Physical Therapy Business Alliance, Private Practice Section, Physical Therapy Provider Network, and a host of individual physical therapists (PTs) around the country are leading relief efforts to help PTs and physical therapy clinics devastated by Hurricane Sandy. 

    The group's relief project, HelpingPTs.org, is collecting donations, equipment, and supplies to help colleagues quickly recover from the devastation so they can get back to treating people affected by the storm and patients.

    Donation checks also can be sent to HelpingPTs.org, 13000 Equity Place, Suite 105, Louisville, Kentucky  40223.

    New York Chapter Relief Fund Information Now Online

    As reported Friday in News Now, the New York and New Jersey chapters have set up relief funds for the physical therapy community affected by Hurricane Sandy, with APTA matching contributions up to $5,000. The New York Chapter's donation page now is live on the chapter's website. The New Jersey Chapter's donation page can be found at the chapter's website. 

    New Resources Available to Help PTs Adopt Cash-based Models

    Physical therapists (PTs) sometimes find that the restrictions placed on their services by third-party payers interfere with their ability to help patients reach their goals. Additionally, the cost of collecting payment from third-party payers and the difficulties in negotiating rates with insurance companies may undermine the financial viability of a PT practice. For these reasons, some physical therapists are choosing an out-of-network, or cash-based, model for their practices. New resources at www.apta.org/Payment/Billing/CashPractice/ can help PTs understand the various types of cash-based practice models, the importance of complying with laws and regulations, and pros and cons of practicing as an out-of-network provider.

    AHA and Hospitals Sue CMS for 'Arbitrary and Capricious' Payment Policy

    Related to the solicitation of public comments regarding Medicare's policy to rebill for subsequently denied inpatient Part A stays under the Medicare Part B outpatient hospital benefit (see News Now article), the American Hospital Association along with a number of hospitals across the country filed a lawsuit in US District Court (The American Hospital Association, et al. v. Kathleen Sebelius, Case No. 1:12-cv-1770) on November 1. In the lawsuit, the plaintiffs contend that the Medicare payment denial policy is "arbitrary and capricious" as it unfairly denies payment to hospitals for medically necessary services that are not statutorily excluded under Medicare Part B. Therefore, the plaintiffs request that the court grant a declaratory judgment affirming that the Centers for Medicare and Medicaid Services' (CMS) payment denial policy is invalid and that CMS has failed to promulgate a regulatory rationale for the application of this arbitrary policy. In addition, the plaintiffs request that the court direct CMS to pay the plaintiffs accordingly for the denied services under the Medicare Part B benefit.

    In its comments to CMS submitted September 4, APTA urged the agency to consider the effect that payment for inpatient hospital services under Medicare Part B might have on the therapy cap for outpatient therapy services. Due to risk of denials when classifying patients for an inpatient stay, APTA explains, there are instances in which a patient's entire stay in the hospitals, sometimes spanning as much 16 days, is classified as an outpatient hospital stay. Therefore, all physical therapy services received during this period as of October 1, 2012, will count toward the therapy cap. "We believe that this is unfair to these patients as it may limit their access to physical therapy in the outpatient setting, when in fact these services should have been billed as inpatient services," says APTA. 

    Review Examines Quality Improvement Measurement of Outcomes for People With Disabilities

    Care coordination literature for people with disabilities is relatively new and focuses on initial implementation of interventions rather than assessing the quality of the implementation, says a new review commissioned by the Agency for Healthcare Research and Quality (AHRQ). The review is part of a series that provides a critical analysis of existing literature on quality improvement strategies and issues for topics identified by the 2003 Institute of Medicine report Priority Areas for National Action: Transforming Health Care Quality. As part of its charge to continuously assess progress toward quality and to update the list of priority areas, AHRQ identified people with disabilities as a priority population.

    For this review, the authors included all forms of disability except severe and persistent mental illness for all age groups in outpatient and community settings. They focused on outcomes, patient experience, and care coordination process measures. They searched for generic outcome measures rather than disability/condition-specific measures. They also looked for examples of outcomes used in the context of disability as a complicating condition for a set of basic service needs relevant to the general population, and secondary conditions common to disability populations.

    Of 15,513 articles screened, 15 articles were included for general outcome measures and 44 studies for care coordination.

    Overall, the reviewfound very few direct examples of work conducted from the perspective of disability as a complicating condition. "Capturing the disability perspective will require collaboration and coordination of measurement efforts across medical interventions, rehabilitation, and social support provision," the authors write.

    The Cost of Chronic Conditions

    A new interactive map from the Robert Wood Johnson Foundation (RWJF) illustrates the prevalence of diabetes, cardiovascular disease, and asthma in adults from 2001 to 2010. Users can breakdown the statistics by educational attainment and race/ethnicity. The map is part of  RWJF's Prevention Saves Lives and Money webpage, which includes studies that highlight prevention initiatives that are effective in improving health and reducing health care costs, in addition to case studies that examine innovative public health initiatives that enhance workplace wellness.  

    November Craikcast Now Available

    In this month's Craikcast Editor in Chief Rebecca Craik, PT, PhD, FAPTA, summarizes the articles in PTJ’s last standard issue for 2012; December is a special issue focusing on critical care. Topics in November's issue include exercise training, extracorporeal shock-wave therapy, health behaviors and role-modeling attitudes of physical therapists and physical therapist students, and falls risk assessment.

    CMS Releases Home Health Prospective Payment System Final Rule for CY 2013

    On November 2, the Centers for Medicare and Medicaid Services (CMS) released the final rule for the Home Health Prospective Payment System (HH PPS) for Calendar Year (CY) 2013. The rule finalizes a reduction in rates of 1.32%, which is approximately a $10 million decrease to payments for the home health 60-day episode for CY 2013.

    Of specific importance to physical therapy, CMS finalizes 3 revisions regarding the requirement that a qualified therapist complete a functional reassessment of the patient at the 14th and the 20th visit, and every 30 days. First, CMS finalized its proposal that if a qualified therapist missed a reassessment visit, therapy coverage would resume with the visit during which the qualified therapist completed the late reassessment, not the visit after the therapist completed the late reassessment. Second, CMS finalized its proposal that in cases where multiple therapy disciplines are involved, if the required reassessment visit was missed for any one of the therapy disciplines for which therapy services were being provided, therapy coverage would cease only for that particular therapy discipline.

    Third, CMS clarifies that in cases where the patient is receiving more than one type of therapy, qualified therapists must complete their reassessment visits during the 11th, 12th, or 13th visit for the required 13th visit reassessment and the 17th, 18th, or 19th visit for the required 19th visit reassessment. However, CMS also states in instances where patients receive more than one type of therapy, if the frequency of a particular discipline, as ordered by a physician, does not make it feasible for the reassessment to occur during the specified timeframes without providing an extra unnecessary visit or delaying a visit, then it will still be acceptable for the qualified therapist from each discipline to provide all of the therapy and functionally reassess the patient during the visit associated with that discipline that is scheduled to occur closest to the 14th Medicare-covered therapy visit, but no later than the 13th Medicare-covered therapy visit. Likewise, a qualified therapist from each discipline must provide all of the therapy and functionally reassess the patient during the visit associated with that discipline that is scheduled to occur closest to the 20th Medicare-covered therapy visit, but no later than the 19th Medicare-covered therapy visit. The final rule reflects APTA's comments urging CMS to maintain the current "close to" language.    

    In addition to the revision to the therapy functional reassessment requirements, CMS also finalizes its proposal to allow a nonphysician practitioner in an acute or post-acute facility to perform the face-to-face encounter in collaboration with or under the supervision of the physician who has privileges and cared for the patient in the acute or post-acute facility, and allow such physician to inform the certifying physician of the patient's homebound status and need for skilled services.

    Lastly, the rule includes extensive provisions regarding the Home Health Conditions of Participation and provides several avenues for home health agencies to meet the survey and certification requirements and lays out CMS' remedial actions if violations are found when surveys are conducted.

    The final rule will be published in the Federal Register on November 8, 2012. APTA will post a summary of the final rule shortly.

    MedPAC Votes on Outpatient Therapy Payment Reform Recommendations

    Yesterday, the Medicare Payment Advisory Commission (MedPAC) voted to adopt several recommendations on outpatient therapy payment reform. These recommendations will be included in a report to Congress that may be used to inform future policy related to outpatient therapy services. Congress has the discretion to determine whether or not to pass legislation that incorporates any of these recommendations. The Centers for Medicare and Medicaid Services also can choose to enact MedPAC's recommendations. APTA will continue to work diligently over the next couple of months with Congress to extend the exceptions process for therapy services in 2013 and to avoid any payment cuts. 

    Overall, MedPAC commissioners expressed appreciation of the value of outpatient therapy services for Medicare beneficiaries and recognized that a "hard cap" with no exceptions would be detrimental and severely impede access to medically necessary therapy services. Several commissioners also acknowledged that, if applied appropriately, therapy presents a beneficial alternative to more costly services, such as surgery and hospital admissions due to falls and other conditions.

    To avoid capping therapy services without an exceptions process, MedPAC recommends that Congress reduce the therapy cap for physical therapy/speech-language pathology combined to $1,270 in 2013 and occupational therapy to $1,270 in 2013, and permanently include hospital outpatient therapy departments under the cap. The cap amount would be updated each year by the Medicare Economic Index. MedPAC also calls for the secretary of the Department of Health and Human Services to implement an improved a manual review process for requests to exceed cap amounts. MedPAC's recommendation to improve the manual medical review process was based on what MedPAC staff described as "constructive feedback" from stakeholder groups, including APTA.

    Other recommendations include applying a multiple procedure payment reduction (MPPR) of 50% to the practice expense component of therapy services provided to the same patient on the same day and reducing the certification period for the outpatient therapy plan of care from 90 to 45 days. MedPAC also voted to direct HHS' secretary to prohibit the use of V codes as a principal diagnosis on outpatient claims.

    To improve management of the benefit in the long term, MedPAC recommends that CMS collect functional status information about beneficiaries using a streamlined, standardized assessment tool that reflects factors such as patient demographic information, diagnosis, medications, surgery, and functional limitations. This information could be used to measure the impact of therapy on functional status and provide a basis for future long-term reform of the payment system.

    In anticipation of the release of these recommendations, APTA has been aggressively engaged on Capitol Hill to ensure payment reforms do not detrimentally impact access, quality, or the financial viability of providers and facilities that play an essential role in the health care delivery system.

    For more information, read APTA's October 9 comments to MedPAC regarding its recommendation to implement a 50% MPPR policy and reduce the therapy cap amount. Additionally, APTA's comments submitted in September address MedPAC's various long- and short-term proposals to reform the Medicare therapy benefit.  

    CMS Issues Final 2013 Physician Fee Schedule Rule

    On November 1, the Centers for Medicare and Medicaid Services (CMS) released the final 2013 Medicare physician fee schedule rule, which sets the therapy cap amount on outpatient therapy services for 2013 at $1,900; updates 2013 payment amounts for physicians, physical therapists, and other health care professionals; and revises other payment policies. The therapy cap exceptions process will expire on December 31 unless Congress acts to extend it. Additional policies that will impact physical therapists include implementation of new functional status codes for reporting therapy services and updates to the Physician Quality Reporting System (PQRS).

    The final rule includes a 26.5% across-the-board reduction to Medicare payment rates for physicians, physical therapists, and other professionals due to the flawed sustainable growth rate (SGR) formula. Since 2003, Congress had enacted legislation preventing the reduction every year. CMS announces that it is "committed to fixing the SGR update methodology and ensuring these payment cuts do not take effect." Excluding the 26.5% projected SGR payment cut, the aggregate impact on payment of changes in the rule for outpatient physical therapy is a positive 4% in 2013. 

    As required by the Middle Class Tax Relief Jobs Creation Act of 2012, CMS will begin to collect data on claim forms about patient functional status for patients receiving outpatient physical therapy, speech therapy, and occupational therapy beginning January 1, 2013. Therapists will be required to report new G codes accompanied by modifiers on the claim form that convey information about a patient's functional limitations and goals at initial evaluation, every 10 visits, and at discharge. This data is for informational purposes and not linked to reimbursement. Until July 1, 2013, claims will be processed regardless of the inclusion of functional limitation codes. Beginning July 1, 2013, all claims must include the functional limitation codes in order to be paid by Medicare. APTA's comments on the proposed fee schedule rule had a significant impact in this area of the final rule, which reflects many of the association's recommendations.

    For 2013 the reporting period for PQRS will be based on a 12-month reporting time frame. The bonus payment amount will be .5%. Calendar year 2013 also will be used as the reporting period for the 2015 PQRS payment adjustment of -1.5%. Successful reporting requirements for the program will remain as they were in 2012, requiring that participants report a minimum of 3 individual measures or 1 group measure via claims-based reporting on 50% or more of all eligible Medicare patients, or report a minimum of 3 individual measures or 1 group measure via registry reporting on 80% or more of all eligible Medicare patients. 

    The final rule with comment period will appear in the November 16 Federal Register. APTA will post a detailed summary of the final rule shortly. 

    [Update as of 5:00 pm: APTA's summary of the rule is available at www.apta.org/Payment/Medicare/CodingBilling/FeeSchedule/.] 

    CMS Releases Calendar Year 2013 Final Rule for Outpatient Hospital Services

    On November 1, the Centers for Medicare and Medicaid Services (CMS) issued its Calendar Year (CY) 2013 final rule for the outpatient prospective payment system (OPPS). In the rule, CMS clarifies that it was not the intent of the agency in the CY 2012 OPPS final rule to establish different requirements for critical access hospitals (CAHs) and for OPPS hospitals for the same services. Therefore, physical therapy, speech therapy, and occupational therapy services that are paid under the OPPS are subject to the direct supervision requirements in 42 CFR § 410.27, whether they are furnished in OPPS hospitals or CAHs. The physical therapy, speech therapy, and occupational therapy services that are not paid under the OPPS and are paid instead under the Medicare Physician Fee Schedule are not subject to the direct supervision requirements in § 410.27, whether they are furnished in OPPS hospitals or in CAHs.

    As previously discussed in the proposed rule CMS has implemented the Medicare Part A to Part B Rebilling (AB Rebilling) Demonstration, which allows participating hospitals to receive 90% of the allowable Part B payment for Part A short-stay claims that are denied on the basis that the inpatient admission was not reasonable and necessary. Participating hospitals can rebill these denied Part A claims under Part B and be paid for additional Part B services that would usually be payable when an inpatient admission is deemed not reasonable and necessary. This demonstration is slated to last for 3 years, from CY 2012 through CY 2014.

    In the proposed rule, CMS discussed that when a Medicare beneficiary arrives at a hospital in need of medical or surgical care, the physician or other qualified practitioner must decide whether to admit the beneficiary for inpatient care or treat him or her as an outpatient. In some cases, when the physician admits the beneficiary and the hospital provides inpatient care, a Medicare claims review contractor, such as the Medicare Administrative Contractor (MAC), the Recovery Audit Contractor (RAC), or the Comprehensive Error Rate Testing (CERT) Contractor, determines that inpatient care was not reasonable and necessary and denies the hospital inpatient claim for payment. In these cases, Medicare allows hospitals to rebill a separate inpatient claim for only a limited set of Part B services, referred to as "Inpatient Part B" or "Part B Only" services. The hospital also may bill Medicare Part B for any outpatient services that were provided in the 3-day payment window prior to the admission.

    Hospitals have expressed concern that this policy provides inadequate payment for resources that they have expended to take care of the beneficiary in need of medically necessary hospital care, although not necessarily at the level of inpatient care. Hospitals have indicated that often they do not have the necessary staff (for example, utilization review staff or case managers) on hand after normal business hours to confirm the physician's decision to admit the beneficiary. Thus, for a short-stay admission, the hospital may be unable to complete a timely review and change a beneficiary's patient status from inpatient to outpatient prior to discharge.

    In the proposed rule, CMS indicates that hospitals appear to be responding to the financial risk of admitting Medicare beneficiaries for inpatient stays that may later be denied upon contractor review by electing to treat beneficiaries as outpatients receiving observation services, often for longer periods of time, rather than admitting them as inpatients.

    CMS received approximately 350 public comments, including those from APTA, in response to its solicitation in the proposed rule regarding possible policy alternatives to remedy the issue of Medicare Part A inpatient admissions and observation stays paid under Medicare Part B. Stakeholders urged CMS not to adopt a final policy regarding patient status in this final rule but instead develop an informed course of action in the upcoming months through a formal, ongoing dialogue with all interested stakeholders. A few stakeholders recommended immediate action to limit beneficiary liability for SNF care when the 3-day qualifying hospital stay is subsequently denied and for the difference in beneficiary cost-sharing between hospital inpatient and outpatient services.

    In the final rule, CMS summarizes the feedback received in response to the solicitation in the proposed rule but does not provide responses to the public comments. CMS states that it strictly solicited public comments, and did not propose any changes in policy. CMS states that it will consider the feedback received from the public in its future policymaking.

    APTA will post a summary of the final rule on its website shortly.

    APTA to Match Donations for NY and NJ Relief Efforts

    Following the devastation of Hurricane Sandy, the New York and New Jersey chapters have established relief funds to help the physical therapy community affected by the storm. APTA will match contributions to both of the funds 1:1 up to $5,000. Click here to donate to the New Jersey Chapter's Hurricane Sandy Disaster Relief Fund. At this time, the New York Chapter has not posted a donation link on its website. APTA will provide a link to the fund when it becomes available.

    In addition to the chapter-specific relief efforts, the association will donate $1,000 to the American Red Cross.

    [November 6 Editor’s Note: Information about the New York Chapter's relief fund, and an online donation form, now is available on the chapter's website.] 

    New Podcast: Physical Therapy Services in Palliative Care

    In the latest installment in a series of podcasts on hospice and palliative care, Stephen Gudas, PT, PhD, describes the goals of palliative care—to live better with disease and address the symptoms of illness—and the role physical therapists play in meeting those goals by helping patients preserve function and dignity. Gudas, who practices physical therapy in the cancer rehabilitation program of the Massey Cancer Center at the Medical College of Virginia, also illustrates how a high-functioning palliative care team can meet the needs of patients and their families. 

    APTA will hold an audio conference titled Hospice and Palliative Care: The Collaborative Role of Physical Therapy on Tuesday, November 13, 1:00-2:00 pm ET. Online registration closes 11:00 pm ET Thursday, November 8,or as soon as all available spaces are filled.

    Physical Therapy Listed as a 'Best Job' by CNNMoney

    CNNMoney's Best Jobs in America report ranks physical therapy 8th among the top 100 jobs in the United States. 

    GAO Self-referral Study on Imaging Finds Excessive Costs, 'Unacceptable Risks for Beneficiaries'

    A report issued yesterday by the Government Accountability Office (GAO) based on Part B claims data found that self-referred magnetic resonance imaging (MRI) services increased by approximately 84% from 2004 to 2010, whereas non-self-referred MRI services only increased by roughly 12%.  

    For computed tomography (CT) over the same time period, the number of services performed by self-referrers increased by approximately 107%, in contrast to an increase of roughly 30% by non-self-referrers. GAO also found that in 2010 "providers who self -referred made 400,000 more referrals for advanced imaging services that they would have if they were not self-referring." As a result, GAO concluded that "financial incentives for self-referring providers were likely a major factor driving the increase in referrals."

    Further, GAO estimated the fiscal impact of the 400,000 improper referrals on the Medicare program was "more than $100 million" just in 2010. However, aside from the monetary cost to the nation, GAO also highlighted the "unacceptable risks for beneficiaries" resulting from additional radiation exposure, particularly in the case of CT services, associated with these unnecessary referrals.

    Yesterday's report is the first of a series from GAO on self-referral. Additional reports are expected on self-referral in physical therapy, anatomic pathology, and radiation therapy. 

    Upon release of the report, the Alliance for Integrity in Medicare (AIM)—a coalition of provider organizations, including APTA, committed to ending the practice of inappropriate physician self-referral—applauded the findings. AIM said the report "substantiates our ongoing concerns with the misapplication of the in-office ancillary service (IOAS) exception to the physician self-referral law." The coalition urged Congress to "heed these critical findings and pass legislation to remove advanced diagnostic imaging, anatomic pathology, radiation therapy, and physical therapy from the IOAS exception, while preserving the ability of truly integrated multispecialty practices to continue providing high-value, high-quality care for Medicare beneficiaries under the self-referral law."

    APTA will issue a separate statement, which will be highlighted in an upcoming News Now article, on GAO's report.

    Eliminating physician referral for profit in physical therapy is one of APTA's public policy priorities. The Foundation for Physical Therapy recently awarded a $300,000 high-impact research grant to Jean Mitchell, PhD, to investigate the influence of physical therapy referral characteristics and practices on quality, cost effectiveness, and utilization.

    New in the Literature: Relationship Between Lower Limb Muscle Strength and 6MWT

    The 6-Minute Walk Test (6MWT) distance may be a good indicator of lower limb muscle strength, and lower limb strengthening may improve gait capacity in patients with stroke, say authors of an article published in Journal of Rehabilitation Medicine.

    A total of 24 patients (12 men and 12 women) participated in the study. Muscle strength (Medical Research Council [MRC] scale) and spasticity (modified Ashworth scale) were assessed prior to the 6MWT. Heart rate was recorded at rest and during the 6MWT. Participants were divided into 2 groups: (1) those with a high MRC sum score, and (2) those with a low MRC sum score. The relationship between the 6MWT distance and the other parameters was analyzed using a Spearman's rank correlation coefficient.

    There was a significant and positive relationship between 6MWT distance and lower limb muscle strength, whereas no significant correlations were found between the 6MWT distance and spasticity, resting heart rate, and heart rate during the 6MWT.

    BMJ Announces New Publishing Commitment

    Beginning 2013, BMJ will publish articles on drugs and devices only if the clinical trial data is made available for independent scrutiny—whether industry funded or not.

    In an editorial published October 29, BMJ Editor in Chief Fiona Godlee says the recent "brave and benevolent" decision by GlaxoSmithKline (GSK) to allow access to anonymous patient level data from its clinical trials "really serves to highlight the rank absurdity of the current situation. Why aren't all clinical trial data routinely available for independent scrutiny once a regulatory decision has been made?"

    Under GSK's new policy, an independent panel will assess all requests and access will be granted on the basis of a reasonable scientific question, a protocol, and a commitment from the researchers to publish their results. Godlee says it will be "particularly important to know how many requests are turned down and for what reasons." 

    Godlee also writes that BMJ has intensified its efforts to help resolve a 3-year battle to gain access to full data on oseltamivir (Tamiflu). Taxpayers in the United Kingdom and around the world "have spent billions of dollars stockpiling a drug for which no one except the manufacturer has seen the complete evidence base," she says. 

    Bariatric Surgery for Type 2 Diabetes Named 'Top Innovation' for 2013

    Physicians and researchers at the Cleveland Clinic have voted weight-loss surgery as the top medical innovation for 2013, not for its effectiveness in reducing obesity but for its ability to control type 2 diabetes. 

    People who reach 100 pounds or more above their ideal weight are almost never successful in losing weight and keeping it off for many years, says the clinic announcement. "Many diabetes experts now believe that weight-loss surgery should be offered much earlier as a reasonable treatment option for patients with poorly controlled diabetes—and not as a last resort."

    Bariatric surgery was chosen as the top innovation "because Medicare has broadened its indication for payment, and Medicaid in many states follows Medicare," says Michael Roizen, MD, Cleveland Clinic chief wellness officer, in a Reuters News article. "A lot of the other (private) insurance companies started covering it, so it's much more accessible."

    The clinic's list of the best medical innovations for 2013 also includes an almond-size device implanted in the mouth to relieve severe headaches, a handheld scanner resembling a blow dryer that detects skin cancer, better mammography technology, and new drugs to treat advanced prostate cancer.

    Physicians and researchers at the clinic voted for what they thought were the biggest, most significant innovations from the 250 ideas submitted from their colleagues. One of the main criteria for getting on the list is the number of people that the product or procedure can potentially help, says Reuters.